Myomectomy or conservative management of uterine fibroids: effects on reproductive potential

2021 ◽  
Vol 70 (5) ◽  
pp. 95-104
Author(s):  
Alexandra I. Shapovalova ◽  
Eduard N. Popov ◽  
Elena V. Mozgovaya
Keyword(s):  
Caesarean Section ◽  
Comparison Group ◽  
Uterine Fibroids ◽  
Main Group ◽  
Uterine Myoma ◽  
Laparoscopic Myomectomy ◽  
Inclusion Criteria ◽  
Birth Canal ◽  
Natural Birth ◽  
Uterine Scar

AIM: The aim of this study was to analyze reproductive function, pregnancy and labor in women after laparoscopic myomectomy and in women with unoperated myoma. MATERIALS AND METHODS: The main group consisted of 60 patients aged 25-46 years with a scar on the uterus who had laparoscopic myomectomy. Inclusion criteria were full-term pregnancy, uterine scar after laparoscopic myomectomy for subserosal or intramural uterine myoma (3-10 cm), and myomatous nodules (one to three). The comparison group included 30 women aged 25-46 years who were not surgically treated. Inclusion criteria were full-term pregnancy, subserosal or intramural uterine myoma (3-10 cm), and myomatous nodules (one to three). All patients in the main group underwent laparoscopic myomectomy. In all cases, the myomatous nodule was removed intracapsularly, leaving the leiomyoma pseudocapsule, which, with a deep arrangement of the transmural myomatous nodules, avoided opening the uterine cavity; myomatous nodule morcellation being used. With a deep intramural arrangement of the leiomyoma, the myometrial defect was sutured layer by layer with the application of several rows of endosutures. RESULTS: Six months after myomectomy, the patients underwent MRI of their pelvic organs with contrast. In 95% of cases, the uterine scar had no anatomical insolvency. In assessing the anamnesis, gynecological diseases occurred two times more often in women in the main group: 22 (36.7%) patients resorted to the use of the in vitro fertilization method for pregnancy, while among the patients in the comparison group, there were only two (6.7%) of them (2 = 12.8; р 0.001). In the main group, moderate preeclampsia and gestational diabetes mellitus were twice as common. In the main group, all patients were delivered by caesarean section, of which 83.3% were planned and 16.7% were emergency. In the comparison group, 73.3% of patients were delivered through the natural birth canal and 26.7% by caesarean section (2 = 149, p 0.0001). The most unfavorable signs predisposing to obstetric complications and operative delivery were the presence of multiple nodules (OR = 5.96 (1.09-32.72), p 0.05), the location of the nodule or scar in the uterine bottom (OR = 2.52 (1.00-6.33), p 0.05), and their combination with IVF (OR = 9.09 (2.42-34.07), р 0.01). CONCLUSIONS: In 95% of women, the scar on the uterus after myomectomy was consistent, but all these pregnant women were delivered by cesarean section, mainly for combined indications. However, they carried out the pregnancy safely, with a good outcome for the fetus. In women with uterine myoma and its conservative management, there was a lower rate of aggravated gynecological history and obstetric complications, and 73.3% of them were delivered through the natural birth canal. Despite the increased risk of caesarean section, the presence of uterine fibroids, even of a large size (more than 4 cm), should not be considered as a contraindication to vaginal delivery.

scholarly journals Reproductive outcomes following surgical removal of uterine fibroids

2019 ◽  
pp. 110-118
Author(s):  
A. E. Mitichkin ◽  
Yu. E. Dobrokhotova ◽  
N. Yu. Ivannikov ◽  
V. I. Dimitrova ◽  
O. A. Slyusareva ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Drug Withdrawal ◽  
Uterine Fibroids ◽  
Reproductive Function ◽  
Uterine Myoma ◽  
Surgical Removal ◽  
Birth Canal ◽  
Uterine Arteries ◽  
Natural Birth ◽  
Prospective Comparative Study

The cohort prospective comparative study investigated the efficacy of mifepristone use in patients after surgical treatment of uterine myoma. It was shown that the use of mifepristone at a dose of 50 mg/day in a continuous mode for 3 months after surgical treatment for proliferating uterine myoma led to the absence of recurrences of the disease for 2 years after the drug withdrawal. The use of mifepristone after embolization of uterine arteries allowed to significantly reduce the size of the node by 25% during 12 months and by 50% (p<0.05) after 24 months. Complex treatment of uterine myoma, including myomectomy and drug therapy with mifepristone, allowed to realize reproductive function in 46% of patients, and delivery through the natural birth canal occurred in 24% of patients.

scholarly journals Hormonal and ultrasound features of formation of feto-placental complex in women with beneficial tumours of the uterus

2019 ◽  
pp. 184-190
Author(s):  
E. F. Khamidullina ◽  
L. Yu. Davidyan ◽  
D. R. Kasymova ◽  
A. Yu. Bogdasarov
Keyword(s):  
Pregnant Women ◽  
Ultrasound Imaging ◽  
Comparison Group ◽  
Clinical Manifestations ◽  
Uterine Fibroids ◽  
Genetic Mutation ◽  
Main Group ◽  
Biochemical Tests ◽  
Almost All ◽  
Ultrasound Features

The purpose and objectives of the study is to identify the hormonal, biochemical and ultrasound features of the gestation course in women with beneficial tumours of the uterus. Results. We conducted a complete clinical examination and prospective observation of 182 pregnant women. Of which, 98 puerperas with a verified diagnosis of uterine fibroids and/or endometriosis, which developed before gestation, but did not prevent the onset of pregnancy, were included into the main group. The comparison group included 84 women with physiological pregnancy. The studies showed that 14 pregnant women in the main group had C677T (Ala222Val) T/T mutation, while only 2 women in the comparison group had a decrease in enzyme activity due to genetic mutation. Accordingly, the homocysteine level was almost 3 times lower in the comparison group than in the main group. The women with hyperhomocisteinemia (HHC) and uterine fibroid in the main group showed the lowest estriol level and hCG level, while women without HHC had higher estriol level and hCG levels. It was found that almost all patients with HHC had subclinical hypothyroidism. Ultrasound imaging and biochemical tests at the beginning of the 2nd trimester: no ultrasound markers of fetal anomalies were identified in women from both groups; however, signs of retrochorial hematoma were detected in 57 women from the main group, which was confirmed by clinical manifestations and previous ultrasound imaging in earlier gestation periods. Conclusion. Thus, placenta formation in women with HHC and uterine fibroids is accompanied by relative hormonal insufficiency, which is clinically manifested as a threat of miscarriage in the early stages, but carrying a child is possible due to appropriate management of a patient as part of the preserving therapy. However, the issue of preventing the development of fetoplacental insufficiency is a valid one for further investigation.

The optimization of reparative processes after cesarean section (clinical-experimental research)

2015 ◽  
Vol 64 (4) ◽  
pp. 4-12 ◽  
Author(s):  
Edvard Karpovich Aylamazyan ◽  
Victoriya Yuryevna Andreeva ◽  
Tatiana Ulyanovna Kuzminykh ◽  
Dmitriy Igorevich Sokolov ◽  
Sergey Alekseevich Selkov ◽  
...  
Keyword(s):  
Pregnant Woman ◽  
Cesarean Section ◽  
Comparison Group ◽  
Main Group ◽  
Control Group ◽  
Collagen Membrane ◽  
Vascular Endothelial ◽  
Actual Direction ◽  
Uterine Scar ◽  
Endothelial Growth Factor

Development and introduction of materials influenced on reparation process in a myometrium is actual direction of modern obstetrics in connection with the increase of cesarean section rate. One of such preparation is «Collost», it stimulates the processes of neoangio- and myogenesis and excludes the disorderly growth of scars tissue. Aim: To study the influence of bioplastic material «Collost» on the reparation process in myometrium after cesarean section. Objectives: to estimate the morpho-functional state of scar on uterus after cesarean sections depending on implantation of collagen membrane. Material and methods: There were included 13 female rabbits in experimental part of the study. In clinical part of the study there were included 20 pregnant woman with intraoperative application of «Collost» (main group), 30 pregnant woman without «Collost» implantation (comparison group) and 10 pregnant with vaginal delivery (control group). Results: histological, immunohistological and immunological findings of postoperative uterine scars of female rabbits showed significant differences of expressions of miosin, vascular endothelial growth factor and collagen I type. The myometrium was significantly thicker in the area of uterine scar in main group (with collagen membrane implantation) than in comparison group. Conclusions: bioplastic material «Collost» leads to full formation of muscular wall and vascular ture in the area of postoperative uterine scar.

The Effective and Safety Use of the Epidural Analgesia at Vaginal Delivery in the Women with the Uterine Scar

10.12737/9077 ◽  
2015 ◽  
Vol 22 (1) ◽  
pp. 50-56
Author(s):  
Виноградов ◽  
V. Vinogradov ◽  
Густоварова ◽  
T. Gustovarova ◽  
Боженков ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Epidural Analgesia ◽  
Vaginal Delivery ◽  
Epidural Anesthesia ◽  
Apgar Score ◽  
Negative Effects ◽  
Birth Canal ◽  
Clinical Hospital ◽  
Natural Birth ◽  
Uterine Scar

The frequency of the Cesarean section leads to increase number of the patients with the scar on the uterus. In the Clinical hospital № 1 (Smolensk, Russia) the childbirth is carried out through natural birth canal on the women having a reliable scar on the uterus. The analysis of the vaginal delivery and labour outcomes in 69 patients with the scar on the uterus is carried out. The childbirth in 38 patients was conducted with the epidurals, in 31 patients – without this type of anesthesia. The efficiency and safety of the epidural anesthesia are shown. The obtained results confirm that the epidural anesthesia doesn&#180;t complicate the labour, doesn&#180;t increase the hospitalization term, doesn&#180;t influence the bleeding and negative effects on the fetus condition and the newborn assessment according to Apgar score. The possibility of using epidural anesthesia at childbirth on the women with uterine scar during the dystocia is shown.

Uterine fibroids, laparoscopic surgery and morcellation: comparative analysis of the results of organ-preserving operations

GYNECOLOGY ◽  
2021 ◽  
Vol 23 (1) ◽  
pp. 73-77
Author(s):  
Alexander A. Seregin ◽  
Anastasiia B. Nadezhdenskaia ◽  
Anna S. Makarova ◽  
Polina L. Sheshko ◽  
Anna V. Tregubova ◽  
...  
Keyword(s):  
Comparative Analysis ◽  
Blood Loss ◽  
Abdominal Cavity ◽  
Uterine Fibroids ◽  
Operation Time ◽  
Main Group ◽  
Laparoscopic Myomectomy ◽  
Control Group ◽  
Tumor Spread ◽  
Plastic Containers

Aim. To conduct a comparative analysis of the results of organ-preserving laparoscopic operations performed for uterine fibroids with the use of plastic containers for morcellation and without it. Materials and methods. We examined 57 patients with a diagnosis of uterine fibroids who were admitted to the Department of Innovative Oncology and Gynecology of the Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology for organ-preserving surgical treatment. To achieve the goal of the study, the patients were divided into the following groups: the main group 29 patients who underwent laparoscopic myomectomy and morcellation of removed nodes using plastic containers. The control group consisted of 28 patients who underwent morcellation during laparoscopic myomectomy without the use of plastic containers. Results. The duration of laparoscopic operations performed using plastic containers main group was 85.6925.87 minutes. Laparoscopic conservative myomectomies, performed without the use of limiting systems, took a slightly longer amount of time control group 88.7530.36 minutes. There were no statistically significant differences, but in the second group, more prolonged sanitation of the abdominal cavity and removal of small fragments of myomatous nodes after morcellation outside the sacs were required. Autoinfusion was used in 6 (20.69%) patients in the main group, in 7 (25%) patients in the control group. Blood transfusion was not used in any case. Average blood loss was 120.6967.50 ml in the main group, 125.0099.54 ml in the control. The duration of hospitalization in the main group was 4.661.76 days, in the control group 5.793.62 days. In the main group, histological examination revealed leiomyoma in all cases, leiomyoma was detected in 96.4% (27 patients) of cases in the control group, and leiomyosarcoma in 1 patient (3.6%). Conclusion. In all groups of patients, there was a favorable course of the postoperative period, early activation of patients. In the group of laparoscopic operations, one patient (3.6%) after morcellation of the myomatous node without the use of a plastic container was found to have leiomyosarcoma. The use of plastic containers in our study did not increase the duration of operations and did not affect the volume of blood loss, the frequency of intra- and postoperative complications. In contrast, the operation time was slightly higher among patients who were operated without the use of containers. In all likelihood, this was due to the fact that the morcellation stage itself took longer, since it was required to extract small fragments of myomatous nodes, as well as thorough and prolonged sanitation of the abdominal cavity. It should be noted that the use of plastic containers, of course, requires the development of certain skills from the surgeon, taking less and less time in parallel with the learning curve. Of course, further studies are required to assess the risk of tumor spread in patients undergoing surgery using plastic containers, but preliminary data indicate that ablastic morcellation can and should be used in organ-preserving surgery for uterine myoma.

Prenatal diagnosis of Down syndrome in pregnant woman with giant uterine myoma and hereditary thrombophilia

2018 ◽  
pp. 24-29
Author(s):  
N.P. Veropotvelyan ◽  
◽  
L.V. Gazarova ◽  
Yu.S. Pogulyay ◽  
E.S. Savarovskaya ◽  
...  
Keyword(s):  
Pregnant Woman ◽  
Prenatal Diagnosis ◽  
Down's Syndrome ◽  
Down’S Syndrome ◽  
Uterine Myoma ◽  
Operative Delivery ◽  
Birth Canal ◽  
Uterine Myomas ◽  
Prophylactic Measures ◽  
Natural Birth

The article describes the case of prenatal diagnosis of Down’s syndrome in a 17 weeks of gestation fetus in a 39-year-old pregnant woman with the first detected giant necrotic uterine myoma and a tendency to hypercoagulable against the background of the heterozygous carriage of the Leyden mutation. At 20 weeks of gestation, due to the inability to proliferate through the natural birth canal, extirpation of the uterus with the fetus (without appendages) was carried out along the Rhine-Poros. At autopsy the diagnosis was confirmed. Timely medical and prophylactic measures allowed to avoid the development of thrombogenic complications. The article discusses the complications of the course of pregnancy with uterine myomas, as well as the features of the echographic pattern of degenerative changes in the myomatous nodes, indications for an operative delivery for uterine myomas, and the frequency of carriage of the Leiden mutation in the population. Key words: uterine myoma, Leyden mutation, ultrasound diagnosis,invasive prenatal diagnosis, Down’s syndrome.

Pregnancy management in patients with uterine fibroids. Case report

GYNECOLOGY ◽  
2021 ◽  
Vol 23 (5) ◽  
pp. 448-453
Author(s):  
Iuliia E. Dobrokhotova ◽  
Sonia Zh. Danelian ◽  
Ekaterina I. Borovkova ◽  
Elena A. Nagaitseva ◽  
Dzhamilia Kh. Sarakhova ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Uterine Fibroids ◽  
Uterine Cavity ◽  
Pain Syndrome ◽  
First Trimester ◽  
Reproductive Age ◽  
Node Degree ◽  
Birth Canal ◽  
Large Size ◽  
Natural Birth

Uterine fibroids (UF) are the most common tumor in women of reproductive age. The growth of myomatous nodes during pregnancy is non-linear and mainly occurs in the first trimester. In most cases, UF do not burden the course of pregnancy. Large size (5 cm), retroplacental location, and/or deformity of the uterine cavity by the myomatous node are associated with increased risks of spontaneous miscarriage, placental abruption, bleeding, preterm birth, and cesarean section. Myomectomy during pregnancy is undesirable, with the development of pain syndrome, the use of acetaminophen is safe. Indications for cesarean section in UF are the presence of a large size of fibroids that prevent delivery through the natural birth canal, red degeneration of myomatous nodes, torsion of the subserous myomatous node (degree 2C).

Informative application of the instrumental diagnosis of scar integrity in the experimental model of the uterine cavity

2021 ◽  
Vol 69 (6) ◽  
pp. 17-22
Author(s):  
Anastasia Yu. Alekseeva ◽  
Marina N. Mochalova
Keyword(s):  
Clinical Trials ◽  
Experimental Model ◽  
Information Content ◽  
Uterine Cavity ◽  
Birth Canal ◽  
Early Postpartum Period ◽  
Early Postpartum ◽  
Natural Birth ◽  
Manual Examination ◽  
Uterine Scar

Currently, the frequency of deliveries by cesarean section is steadily increasing. Independent childbirth in women with a uterine scar is one of the mechanisms of its reduction. Meanwhile, the delivery of this category of patients through the natural birth canal requires the development of a safe and effective method for assessing scar integrity in the early postpartum period. For this purpose, a new instrumental diagnostics method has been developed, with its information content compared to manual examination data in an experimental model of the uterus. Each model was made of a bovine heart and had three defects with diameters less than 0.5 cm, 0.5-0.8 cm and 0.8-1.2 cm. Defects with diameters less than 0.5 cm were not detected by any of the methods studied. Defects with a diameter of 0.5-0.8 cm were detected using the developed device in 90 % (45/50) of cases and using manual examination in 44 % (22/50) of cases (2 = 23.93, p 0.001), defects with a diameter of 0.8-1.2 cm being detected in 100% (50/50) and 98% (49/50) of cases, respectively (2 = 1.01, p = 0.32). The information content of the instrumental model exceeds that of the manual study by 1.34 times (RR = 1.34, 95 % CI 1.09-1.65, p 0.05). Therefore, the possibility of testing this device in clinical trials needs to be considered.

scholarly journals INTEGRATED PREPARATION OF PREGNANT WOMEN WITH A UTERINE SCAR TO VAGINAL PARTURITION

2019 ◽  
Vol 6 (1) ◽  
pp. 38-42
Author(s):  
E. P Shevtsova ◽  
Anatoly E. Miroshnikov ◽  
Yu. A Shatilova ◽  
N. A Zharkin
Keyword(s):  
Cesarean Section ◽  
Pregnant Women ◽  
Vaginal Delivery ◽  
Previous Cesarean Section ◽  
Birth Canal ◽  
Natural Birth ◽  
Uterine Scar ◽  
Previous Cesarean

Attempts of vaginal delivery in cases with a scar on the uterus after a previous cesarean section are more successful after appropriate psycho-prophylactic preparation during pregnancy. The purpose of the study is to reduce the frequency of repeated cesarean section operations. A comparison was made of the methods of delivery for pregnant women with a scar on the uterus after comprehensive training on an improved program and unprepared pregnant women. A total of 158 women were included in the study. Among them were those who had a cesarean section in history, but not trained for the current childbirth, only 5% gave birth independently. At the same time, women trained under the improved program had independent deliveries in 45.6% of cases (OR 5.813; 95% CI 0.826-40.885). The results confirm the effectiveness of the proposed improvements in the preparation of pregnant women with a scar on the uterus. The intention of such women to give birth through the natural birth canal, formed as a result of preparation, is an important factor for successfully overcoming the difficulties of the delivery process.

Thromboembolic complications prevention in the obstetric practice

2017 ◽  
pp. 19-24
Author(s):  
O.V. Grishchenko ◽  
◽  
V.V. Bobrytska ◽  
Keyword(s):  
Pulmonary Embolism ◽  
Comparison Group ◽  
Main Group ◽  
Control Group ◽  
Efficacy And Safety ◽  
Thromboembolic Complications ◽  
Moderate Risk ◽  
Obstetric Practice ◽  
Thrombotic Complications ◽  
And Control

The objective: To evaluate the clinical efficacy and safety of Enoxaparin-Pharmex for the prevention of thrombotic complications (pulmonary embolism) in the postoperative period in patients with moderate risk of these complications. Patients and methods. The study included 50 women after a caesarean section had an average degree of risk of pulmonary embolism. Patients were divided into the main group (n=25) and control group (n=25) in accordance with the treatment: patients of the main group received postoperative Еnoxaparin- Pharmex, group comparisons enoxaparin sodium (brand foreign manufacturer’s). Patients in both groups received the drug at a dose of 20 mg for 5 days, 1 time per day subcutaneously. Results. The research data analysis showed identity results of hemostasiogram of patients in the main group and the comparison group, no side effects after treatment in both groups. Conclusion. The clinical studies suggest the drug Enoxaparin-Pharmex is effective, safe LMWH, which can be used to prevent troboembolic complications, including post-operative treatment in obstetric practice. Spectrum of Enoxaparin-Pharmex can be extended to the prevention and treatment of thromboembolic conditions of varying severity with appropriate doses of the drug. Key words: Enoxaparin-Pharmex, prevention of pulmonary embolism.

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